A stomach ulcer is a defect in the lining of the stomach. This defect causes trophic disturbances.
A duodenal ulcer is formed by the action of pepsin and acid on the mucous membrane of the organ. It primarily occurs in people with hypersensitivity.
Statistics show that about a tenth of the world's population suffers from peptic ulcer disease. Interestingly, men are more susceptible to developing this disease than women.
Duodenal ulcers are much more common than stomach ulcers. If there are ulcers both in the duodenum and in the stomach, then they are called combined.
Peptic ulcer disease is a chronic process. Peptic ulcer disease lasts a long time, its manifestations depend on many factors: on the stage of the disease, age and sex of the patient, season and some other factors.
Peptic ulcer disease is characterized by a recurrent course. This means that periods of exacerbation (from one week to two months) alternate with periods of remission. During the period of remission, a person is able to feel completely healthy and not have any complaints. Exacerbations of peptic ulcer disease most often occur in spring or autumn, that is, we can talk about the seasonally expressed nature of peptic ulcer disease. The difference between peptic ulcer disease and erosion (with erosion, the defect of the mucous membrane is superficial, and consists in the fact that after the healing of the ulcer, a scar remains.
Ulcerative lesions are determined by infection with Helicobacteria. More than 80% of ulcerative lesions of the stomach and duodenum are associated with infection with this microorganism. But only 20% of people infected with helicobacteria develop peptic ulcer disease of these organs. The reason for this, according to doctors, is the general state of immunity in humans, as well as the features of the protective properties of the mucous membrane and acidity.
If there is a duodenal ulcer, then a stomach ulcer is guaranteed. This common statement is far from true. Indeed, such combined ulcers sometimes occur, but, as medicine proves, they occur only in less than 10% of patients with peptic ulcer disease.
Peptic ulcer disease is characterized by the presence of a pre-ulcer period. Its manifestations: pain an hour and a half after eating, night pains in the epigastric region, hunger pains. The disease itself begins acutely. The term “pre-ulcer” has not always been used lately. Patients who complain of these symptoms are at increased risk of developing this disease.
Pain is the main symptom of gastric ulcer and duodenal ulcer. Pain in the epigastric region accompanies the primary ulcer formation. Pains can be early, late, hungry, or nocturnal. With an ulcer of the upper stomach, early pains occur - they appear half an hour or an hour after eating. They tend to get stronger. This is due to an increase in the concentration of hydrochloric acid in the stomach. After another hour or two, the pains become less severe. This fact is explained by the fact that food from the stomach enters the duodenum. Late pains are observed after a longer period of time after a meal - about two hours. This type of pain is also typical for chronic pancreatitis. Hunger pains appear after a considerable time after eating - after five to six hours - they tend to diminish after the next meal. Night pains are like hunger pains. Hunger and night pains are characteristic of duodenal ulcers.
The localization of pain in gastric ulcer and duodenal ulcer is different. Stomach ulcer is characterized by pain on the left side, in the upper abdomen, or along its midline. For duodenal ulcer disease, pain to the right of the midline is characteristic. Also, the pain can be given to the back or be retrosternal. The nature of the pain itself is varied: most of the patients with this diagnosis have dull or aching, stabbing or boring; in a third of patients, pain is very strong.
Heartburn is a common occurrence in peptic ulcer disease. A person feels a burning sensation in the neck or behind the breastbone. The most common cause of heartburn is when stomach contents enter through the lower opening of the esophagus. It is not uncommon for heartburn to be the only sign of an ulcer. Another fairly common symptom of peptic ulcer disease is belching, which predominantly has a sour taste. The reason for this is the high acidity of the contents of the stomach.
Nausea is a characteristic sign of peptic ulcer disease during its exacerbation. With duodenal ulcers, nausea occurs quite often. With gastric ulcer, nausea occurs much less frequently. As for vomiting, it occurs only at the height of the pain; the patient feels better after vomiting.
Losing weight is a process inherent in the course of peptic ulcer disease. Not entirely true statement. The fact is that a patient can lose weight during an exacerbation of this disease. The rest of the time (except for exacerbations), the patient has a normal appetite or even increased (but obesity in patients is extremely rare).
Constipation is a common occurrence in peptic ulcer disease. About half of all patients complain of constipation. Their cause may be a violation of the intestinal motor function. Constipation can also be caused by taking antacids.
A lot of research is needed to make a diagnosis of peptic ulcer disease. X-rays of the stomach and intestines are mandatory. Fibrogastroduodenoscopy is also necessary and consists in taking pieces of mucous membrane along the edge of the ulcer. Pieces of the mucous membrane are examined to determine the presence of Helicobacteria. In addition, the general functional state of the organs on which an ulcer can be found (stomach and duodenum) is examined in the patient. Stool analysis (for occult blood), biochemical blood test and complete blood count are performed.
Peptic ulcer treatment is based on many components. Firstly, with a peptic ulcer, rest and the exclusion of all possible stressful situations is necessary. Hospitalization can be carried out during an exacerbation of the disease. Secondly, and this is an important component, diet is recommended. In this regard, the food consumed by the patient must contain a lot of proteins. This is necessary due to the fact that it is the protein food that promotes the healing of ulcers. Basically, these are meat, eggs, fish. Eggs as well as milk bind hydrochloric acid. As a result, the acidity of the gastric contents decreases. The patient with peptic ulcer should be familiar with the principles of sparing the gastric mucosa. Mechanical sparing includes the elimination of dry and coarse foods from the diet, as well as steaming foods. Thermal sparing involves eating warm food. The exclusion of various spices, smoked meats and sour foods from the diet form the basis of chemical sparing of the mucous membrane of the stomach and duodenum. Based on the data of the conducted research, the doctor prescribes treatment for the patient, which includes an antibiotic, antimicrobial drug, a proton pump inhibitor - according to this scheme, the patient is treated for one to two weeks. The course of treatment is aimed at destroying Helicobacteria. Treatment is based on the fact that the patient will fully adhere to the doctor's prescriptions, because unauthorized interruption of the course of treatment can lead to the fact that Helicobacter pylori will become resistant to the prescribed drugs.
Peptic ulcer requires fractional nutrition. You need to take food five to six times a day in small portions. In the case of a peptic ulcer, overeating and drinking alcohol is unacceptable. Smokers are advised to quit this bad habit, or at least reduce smoking, since it is known that smoking does not contribute to ulcer healing in any way.
Complications of peptic ulcer disease occur suddenly. This refers to the complications of the first group. These complications threaten the patient's life (ulcer perforation, bleeding). Therefore, urgent intervention is needed. The second group includes chronic complications. These are, for example, pyloric and duodenal stenosis, ulcer malignancy, pancreatitis and hepatitis (which are associated with an ulcer).
A perforated ulcer is a serious complication of an acute or chronic ulcer. If we are talking about an exacerbation of chronic peptic ulcer disease, then the perforation of the ulcer is most often found during exacerbations. A perforated ulcer (ulcer perforation) occurs when a through defect appears in the wall of the stomach or duodenum. The latter usually opens into the retroperitoneal space or the abdominal cavity. The consequence of perforation of the ulcer is the ingress of gastroduodenal contents into the abdominal cavity. It acts on the abdominal surface of the irritant, peritonitis develops. A complication such as ulcer perforation occurs in 10% of gastric and duodenal ulcers. Perforated ulcers are more common in men than in women. Perforation is possible between the ages of 20 and 40.
Perforation of the ulcer is characterized by "dagger" pain. Before the perforation itself, in about four days, patients complain of a sharp exacerbation of peptic ulcer disease, after which there is a strong "dagger" pain in the abdomen, which tends to increase. There are three stages of this disease. The first one is reflex, it lasts up to six hours. The second - imaginary well-being, lasts for six to twelve hours. It is characterized by a decrease in pain and an improvement in the general condition of the patient. However, due to the fact that peritonitis progresses, the general condition of the patient worsens. In this regard, the third stage of the disease is distinguished - the progression of peritonitis, they last more than twelve hours. There are several known signs on the basis of which the doctor can correctly determine the disease. These include a history of ulceration, which is present in 80-90% of cases, "dagger" pain, a hard abdomen, and the presence of tachycardia at normal body temperature.
Perforation of the ulcer requires surgical treatment. Before the operation, premedication with antibiotics is performed (in order to prepare the body for the operation). With diffuse purulent peritonitis, the perforation is sutured. The stomach ulcer gives the basis for its resection.
Penetration (penetration) of stomach and duodenal ulcers is a complication of peptic ulcer disease. If a chronic ulcer destroys the wall of the stomach or duodenum, it is possible for the ulcer to penetrate into other organs and tissues. Stomach ulcers often penetrate (penetrate) into the lesser omentum, less often into the abdominal wall. In this case, constant pain is a characteristic feature. Duodenal ulcers often penetrate the pancreas. To diagnose a penetrating ulcer, it is necessary to conduct the following studies. These are fibrogastroscopy and X-ray examination. A penetrating ulcer can lead to perforation of the ulcer, inflammation of the organs into which the ulcer penetrates, and some other complications.
Treatment of a penetrating ulcer is surgical. Not at all necessary. The decision on surgical intervention is applied only if conservative therapy has not yielded results.
Pylorus stenosis is a complication of peptic ulcer disease. This disease occurs due to scarring of ulcers that are located in the initial part of the duodenum or pyloric canal. The complaints of patients in this case are associated with discomfort in the stomach. Belching and vomiting are also characteristic manifestations of pyloric stenosis.